Department of Anesthesiology, Emory University School of Medicine, Cardiothoracic Anesthesiology and Critical Care, Emory Healthcare, Atlanta, GA 30322, USA.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):662-7. doi: 10.1016/j.jtcvs.2011.03.015. Epub 2011 May 5.
Bleeding after cardiac surgery remains a significant problem, increasing both length of stay and mortality, and is caused by multiple factors including dilutional changes, ongoing fibrinolysis, and platelet dysfunction. The evaluation of coagulopathy is problematic because of the long turnaround time of standard coagulation tests. Algorithms involving point of care testing, including thromboelastography and thromboelastometry, have been published; all have the potential to reduce transfusion requirements. Massive transfusion coagulopathy that occurs in trauma can also be seen in complex aortic surgery and other massive bleeding patients and should prompt consideration of a transfusion protocol involving fixed ratios of fresh frozen plasma, platelets, and red blood cells. Pharmacologic agents such as antifibrinolytics are commonly administered, but a multimodal approach to management is important. Recombinant and purified coagulation products are being studied and provide clinicians specific agents to treat targeted deficiencies. A general multi-modal approach is required and recommendations are made for the management of bleeding and coagulopathy in cardiac surgical patients.
心脏手术后出血仍然是一个严重的问题，会延长住院时间并增加死亡率，其原因包括稀释性改变、持续的纤维蛋白溶解和血小板功能障碍。由于标准凝血测试的周转时间较长，凝血功能障碍的评估存在问题。涉及即时检测的算法，包括血栓弹力图和血栓弹力测定法，已经发表；所有这些都有可能减少输血需求。创伤中发生的大量输血性凝血功能障碍也可见于复杂的主动脉手术和其他大量出血患者，应考虑采用包含新鲜冷冻血浆、血小板和红细胞固定比例的输血方案。通常给予抗纤维蛋白溶解药物等药物，但重要的是要采取多模式管理方法。正在研究重组和纯化的凝血产品，并为临床医生提供特定的药物来治疗有针对性的缺陷。需要采用一般的多模式方法，并为心脏手术患者的出血和凝血功能障碍管理提出建议。
